Lombalgia em equinos de vaquejada: achados clínicos, ultrasonográficos e resultados terapêuticos de 25 casos / Back pain in vaquejada horses: clinical, ultrasound findings and therapeutic outcome in 25 cases

25 equinos da raça Quarto de Milha, em atividade esportiva na modalidade de vaquejada no estado do Rio Grande do Norte, Brasil, ambos os sexos, com idade média de 7,91 + 3,26 anos, foram examinados na propriedade de origem ou centro de treinamento para diagnóstico de baixo desempenho associado a dor lombar. O exame clínico da região toracolombar foi realizado por meio da inspeção, palpação, testes de mobilização (ventro e dorsoflexão toracolombar; flexão lateral e rotação toracolombar; flexão lateral e rotação cervical e torácica) além de análise do animal em movimento. As principais alterações encontradas foram miosite epaxial, desmite ligamento supra-espinhoso, além de atrofia do músculo multifidus. O tratamento clínico consistiu na administração de injeções periespinhais de triancinolona numa dose total de 200mg, além de exercício controlado. Após o tratamento, todos os animais retornaram a desempenhar suas atividades atlética em nível de desempenho superior ou igual ao demonstrado antes do diagnóstico e tratamento da lombalgia.

Twenty five horses of the Quarter horse breed, in sporting activity in the vaquejada modality in the state of Rio Grande do Norte, Brazil, 15 males and 10 females, with an average age of 7.91 + 3.26 years, were examined in the property of origin or training center for low performance diagnosis associated with low back pain. The clinical examination of the thoracolumbar region was performed through inspection, palpation, ultrasonography, mobilization tests (ventral and thoracolumbar dorsoflexion; lateral flexion and thoracolumbar rotation; lateral flexion and cervical and thoracic rotation) in addition to analysis of the animal in motion. The main changes found were epaxial myositis, supraspinatus desmite, as well as atrophy of the multifidus muscle. Clinical treatment consisted of administering perispinal injections of triamcinolone Acetonide in a total dose of 200mg, in addition to controlled exercise. After treatment, all animals returned to performing their athletic activities at a performance level greater than or equal to that demonstrated before the diagnosis and treatment of low back pain.

Lombalgia em equinos de vaquejada: achados clínicos, ultrassonográficos e resultados terapêuticos de 25 casos / Back pain in vaquejada horses: clinical, ultrasound findings and therapeutic outcome in 25 cases

Vinte e cinco equinos da raça Quarto de Milha, em atividade esportiva na modalidade de vaquejada no estado do Rio Grande do Norte, Brasil, 15 machos e 10 fêmeas, com idade média de 7,91 + 3,26 anos, foram examinados na propriedade de origem ou centro de treinamento para diagnóstico de baixo desempenho associado a dor lombar. O exame clínico da região toracolombar foi realizado por meio da inspeção, palpação, ultrasonografia, testes de mobilização (ventro e dorsoflexão toracolombar; flexão lateral e rotação toracolombar; flexão lateral e rotação cervical e torácica) além de análise do animal em movimento. As principais alterações encontradas foram miosite epaxial, desmite supra-espinhosa, além de atrofia do músculo multifidus. O tratamento clínico consistiu na administração de injeções periespinhais de Acetonida de triancinolona numa dose total de 200mg, além de exercício controlado. Após o tratamento, todos os animais retornaram a desempenhar suas atividades atlética em nível de desempenho superior ou igual ao demonstrado antes do diagnóstico e tratamento da lombalgia.

Twenty five horses of the Quarter horse breed, in sporting activity in the vaquejada modality in the state of Rio Grande do Norte, Brazil, 15 males and 10 females, with an average age of 7.91 + 3.26 years, were examined in the property of origin or training center for low performance diagnosis associated with low back pain. The clinical examination of the thoracolumbar region was performed through inspection, palpation, ultrasonography, mobilization tests (ventral and thoracolumbar dorsoflexion; lateral flexion and thoracolumbar rotation; lateral flexion and cervical and thoracic rotation) in addition to analysis of the animal in motion. The main changes found were epaxial myositis, supraspinatus desmite, as well as atrophy of the multifidus muscle. Clinical treatment consisted of administering perispinal injections of triamcinolone Acetonide in a total dose of 200mg, in addition to controlled exercise. After treatment, all animals returned to performing their athletic activities at a performance level greater than or equal to that demonstrated before the diagnosis and treatment of low back pain.

Treatment of patients with metastatic colorectal cancer and poor performance status: current evidence and challenges

Patients with unresectable metastatic colorectal cancer live for a median of three years when treated with standard therapies. While the evidence guiding cancer-directed treatment of this disease comes from phase III trials that have mostly enrolled patients with good performance status, some patients present with poor clinical conditions. The best treatment for these patients remains to be determined. We performed a systematic review of the treatment outcomes of patients with metastatic colorectal cancer and poor performance status, defined as Eastern Cooperative Oncology Group performance status ≥2. Eligible articles were prospective or retrospective studies or case reports published in English, Portuguese or Spanish. We searched PubMed, EMBASE, LILACS and the Cochrane Library from onset until October 2017 using specific keywords for each search. We found a total of 18 publications, mostly case reports and retrospective studies (14 articles). One was an uncontrolled prospective trial, two were observational studies and one was an individual patient meta-analysis. Although some studies suggested benefits in terms of symptomatic response with standard chemotherapy, with good safety profiles when dose-reduced regimens were administered, a true survival gain could not be demonstrated. The scientific evidence for treating metastatic colorectal cancer patients with poor performance status is scarce, and more studies evaluating treatment for this population are necessary since this condition is not uncommon in clinical practice, particularly in the public healthcare system and developing countries and among destitute populations.

Tolerance of weekly paclitaxel and carboplatin as neoadjuvant chemotherapy in advanced ovarian cancer patients who are unlikely to tolerate 3 weekly paclitaxel and carboplatin.

OBJECTIVE: There are little data regarding safety and effectiveness of neoadjuvant chemotherapy (NACT) in patients who are considered unfit for receiving 3 weekly paclitaxel and carboplatin. The aim of this study was to study the toxicity and response rates of weekly paclitaxel and carboplatin as NACT in such cohort of patients. METHODS: Study population included advanced ovarian cancer patients who were unlikely to tolerate 3 weekly paclitaxel and carboplatin and hence received weekly paclitaxel (80 mg/m2) and carboplatin AUC‑2 as NACT. The data regarding the baseline characteristics, chemotherapy tolerance, completion rates, toxicity (CTCAE version 4.02), and radiological response rates are presented. SPSS version 16 was used for analysis. Descriptive statistics is presented. RESULT: Eleven patients received this schedule. Nine patients completed nine cycles of NACT. Except one, all patients completed NACT with an average relative dose intensity of >0.8. There was no chemotherapy‑related mortality. Grade 3–4 life‑threatening complications were seen in two patients. The post NACT response rate was 100%. CONCLUSION: Weekly paclitaxel and carboplatin chemotherapy is safe and efficacious in patients who are unsuitable for 3 weekly paclitaxel and carboplatin chemotherapy schedules.

Weekly chemotherapy as Induction chemotherapy in locally advanced head and neck cancer for patients ineligible for 3 weekly maximum tolerable dose chemotherapy.

OBJECTIVE: To study the safety and efficacy of weekly chemotherapy as part of induction chemotherapy, in locally advanced head and neck cancer for patients, who are unfit for upfront radical treatment. MATERIALS AND METHODS: It is a retrospective analysis of on‑use weekly chemotherapy as Induction chemotherapy in locally advanced head and neck cancer, who are technically unresectable are unfit for upfront radical treatment. Induction chemotherapy given was a 2 drug combination of paclitaxel (80 mg/m2) and carboplatin AUC 2. The decision to give weekly induction chemotherapy was given on the basis of presence of 2 more following features: Poor performance status (ECOG PS 2‑3), presence of uncontrolled co morbidities, BMI below 18.5 kg/m2 and age more than 60 years. The Statistical Package for the Social Sciences software (SPSS version 16.0) was used for analysis. The response rates, toxicity (accordance with CTCAE vs. 4.02), completion rate (Cp) of radical intent treatment post neoadjuvant chemotherapy (NACT), progression‑free survival (PFS) and overall survival (OS) are reported. RESULTS: Fifteen patients were considered for such therapy. Fourteen out of fifteen patients completed NACT. The median numbers of planned weekly cycles were 6 (3-8). Response (CR + PR) was seen in 10 patients. Overall grade 3-4 toxicity was seen in 6 patients. No toxicity related mortality was noted. The calculated completion rate (Cp) of radical intent treatment post NACT was 46.7%. The median PFS and OS were 10.36 months (95% CI 6.73-14.00 months) and 16.53 months (95% CI 4.22-28.84). CONCLUSION: Use of induction chemotherapy with weekly regimen is safe and effective selected cohort of patients with locally advanced disease who are unfit for upfront radical treatment.